Omental Cake

Definition of Omental Caking

Thickening of the omentum resulting from localized or diffuse infiltration of omental fat by soft tissue density mass is referred as “omental caking”.

It is a radiological sign, which is often identified in CT scan.

Involved Anatomical Structure in Omental Caking

Greater Omentum –¬†an extension of the anterior and posterior visceral peritoneum.

omental cake

Causes of Omental Caking

Metastatic involvement (Commonest)

  1. Ovarian carcinoma (commonest cause)
  2. Colonic carcinoma
  3. Gastric carcinoma
  4. Pancreatic carcinoma
  5. Others: Endometrial carcinoma, Bladder cancer, Renal cell carcinoma, Hepato-biliary malignancies, Melanoma, Lung cancer, Breast cancer

4 routes of spread to omentum:

  1. Direct extension
  2. Intraperitoneal seeding
  3. Hematogenous spread
  4. Lymphatic spread

Primary malignancies and benign tumors of omentum (Rare)

  1. Abdominal mesothelioma
  2. Haemangiopericytoma
  3. Leiomyoma
  4. Leiomyosarcoma
  5. Gastrointestinal stromal tumour (GIST)
  6. Lipoma
  7. Liposarcoma
  8. Neurofibroma
  9. Fibrosarcoma
  10. Small round cell tumours

Infections

  1. Tuberculous peritonitis
  2. Actinomycosis
  3. Coccidiodomycosis
  4. Non-tuberculous mycobacterial infection
  5. Histoplasmosis
  6. Omental paragonimiasis

Unusual Etiologies

  1. Myelofibrosis
  2. Sclerosing omentitis
  3. Amyloidosis

Further Investigation in Omental Caking

Percutaneous CT or US-guided biopsy for primary diagnosis and staging.

References

Mamlouk MD, vanSonnenberg E, Shankar S, Silverman SG. Omental cakes: unusual aetiologies and CT appearances. Insights into Imaging. 2011;2(4):399-408. doi:10.1007/s13244-011-0105-4.

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